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The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value?

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Abstract

In meningiomas, location-specific differences of the prognostic value of the Simpson classification are sparsely investigated but can influence strategy of surgery. We therefore compared the prognostic value of the Simpson classification in different tumor locations. Progression was compared with Simpson grade in 826 meningioma patients (median age 58 years, female:male ratio 2.4) in location-specific uni- and multivariate analyses. Simpson grade strongly correlated with tumor location (p < .001). Within a median follow-up of 50 months, recurrence was observed in 107 of 803 patients (13%). In general, increasing Simpson grade (p = .002) and subtotal resection (STR, ≥grade III) were correlated with tumor recurrence [hazard ratio (HR): 1.87; p = .004]. In 268 convexity meningiomas, frequency of tumor recurrence correlated with Simpson grade (p = .034). Risk of recurrence was similar after grade I and II resections, tended to increase after grade III (HR: 2.35; p = .087) but was higher after grade IV resections (HR: 7.35; p = .003). Risk of recurrence was higher after STR (HR: 4.21; p = .001) than after gross total resection (GTR, ≤grade II). Contrarily, increasing Simpson grade and STR were not correlated with progression in 102 falx, 38 posterior fossa and nine intraventricular meningiomas. In 325 skull base lesions, risk of recurrence was similar after GTR and STR (p = .198) and was only increased after grade IV resections (HR: 3.26; p = .017). Simpson grading and extent of resection were not equally prognostic in all locations. Lower impact of extent of resection should be considered during surgery for skull base, posterior fossa and falx meningiomas.

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Acknowledgements

This research received funding by the Maria Möller Stiftung (recipient BB). The funder was not involved in the design of the study and analysis of the results. There are no financial or intellectual conflicts of interest to disclose.

Funding

This research received funding by the Maria Möller Stiftung (recipient BB).

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, North Rhine-Westphalia, Germany

    Kira Marie Voß, Dorothee Cäcilia Spille, Eric Suero Molina, Walter Stummer, Markus Holling & Benjamin Brokinkel

  2. Institute of Biostatistics and Clinical Research, University Hospital Münster, Münster, North Rhine-Westphalia, Germany

    Cristina Sauerland

  3. Department of Clinical Radiology, University of Münster, Münster, North Rhine-Westphalia, Germany

    Caroline Brokinkel

  4. Institute of Neuropathology, University Hospital Münster, Münster, North Rhine-Westphalia, Germany

    Werner Paulus & Astrid Jeibmann

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  1. Kira Marie Voß
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  2. Dorothee Cäcilia Spille
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Correspondence to Benjamin Brokinkel.

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This is a retrospective, non-interventional study. Data collection and scientific use was approved by the local ethics committee and permitted by the patients in each single case (Muenster 2007-420-f-S).

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Informed consent was obtained from all individual participants included in the study.

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Voß, K.M., Spille, D.C., Sauerland, C. et al. The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value?. J Neurooncol 133, 641–651 (2017). https://doi.org/10.1007/s11060-017-2481-1

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